Risk Assessment and Child Protection: best practice and pitfalls
Ruth Gardner, Advisor : Neglect Theme
Gwynne Rayns, Development Manager: Under Ones Theme
November 2013
RUTH GARDNER
Word of Caution
Best Practice? Pitfalls?
Aims of the session
To discuss
• The basis for renewed interest in risk assessment
• What we mean by risk assessment
• How we can evidence consideration of risk
• How we can measure change
You will
• Learn about some tools in use ; and find out about some examples of what works in effective implementation
Current Practice Context
• Children left too long in sub-optimal parental care (Select Education Committee report 2012)
• Need to work within timely fashion to meet children’s developmental timeframes (Ward 2012)
• Revolving door syndrome – repeat referrals
• Specialist assessments build delays in courts
• Lack of robust planning and clarity regarding the changes a family must make to exit the system
• Lack of purposeful monitoring
Context of “Risk” Assessment
• A core social work activity, but little guidance
• At the heart of good child protection work is risk identification, risk assessment and risk management
• Can mean accountability for decisions
• Requires evidence for underpinning decisions
• Shared multi-agency definition of risk
• Following procedures is not necessarily the same as managing risk well
Possible time - points for Risk Assessment
What do we mean by “risk” Assessment
Different from assessment
• Assessment Framework DH 2000
• Cross sectional assessment of parents current ability to meet the child’s needs
• Gather information about past history, previous concerns, previous intervention, current concerns and current functioning
What do we mean by “risk” Assessment
Risk of significant harm
• What is the harm – what is the concern
• What is the impact on each individual child
• How severe is this – analysis and judgement
• How likely to happen again – judgement and prediction
• Risk (chances) of potential outcomes
What do we mean by “risk” Assessment
Balance: risk and protective factors
Decision making
• Practitioners are prone to making errors when making decisions under conditions of uncertainty (Baumann et al 2011)
• Less or more protective intervention errors (Corby study 2003) – Less = lack of intervention when there should have
been some, often in families with multiple stressors, little consistent follow up work
– More = leads to more CP case conferences that do not lead to registration
Prediction: an outcome framework
Child maltreatment present
Yes No
Take a
cti
on
No
Yes
True negative prediction
eg harmful behaviour will
not occur
False negative prediction eg
risk of harm not identified
but does occur ; the
consequences are acute
False positive prediction eg
risk of harm predicted but
does not occur – query over-
intervention
True positive prediction
eg harmful behaviour will
occur
From Information to Intelligence STRONG EVIDENCE
WEAK or NO EVIDENCE
Strongly Held View
Unclear or No View
4. FIRM GROUND Intelligence
1. Ambiguous Information
2. Missing Information
3. Assumption-led Information
Jones, Hindley and Ramchandani, 2006).
• Available on Research in Practice website
• Sections on factors which make: Significant harm more/less likely
• This tool is only suitable for use in cases in which there is evidence of previous child maltreatment to the child or other children by one or both parents/carers.
Judgements and Decisions
• Judgements of Risk: to make a decision on the most appropriate course of action (ie to remove a child) we must first make a judgement of risk
• Decision thresholds: the point the level of risk needs to be to make the decision (ie the line in the sand)
• Decision thresholds are independent of judgements of risk
• Practitioners may make different decisions for 2 reasons: they make a different estimate of risk or they vary in their decision thresholds
Barlow, Fisher & Jones ( 2012, DFE) Review models of assessing significant harm
• Practitioners good at info gathering but find it challenging to analyse complex information in order to make judgements about significant harm -
• Concern re poor accuracy of CP decisions “only slightly better than guessing” ( REF 3 Dorsey )
• Increasing consensus about need to move towards Structured Professional Judgement = decision making supported by the use of standardised tools including SAAF ; S of S ; GCP .
Types of risk assessment ( Barlow et al)
In order of increasing accuracy ( REF 4) • Guessing • Unaided clinical judgement • Consensus based tools (=factors practitioners typically
use) • Empirical tools : Structured Professional or Clinical Judgement (=structured guidelines) Actuarial (=only statistically predictive factors) BUT EACH APPROACH HAS LIMITATIONS
Limitations in their use for child protection
• Unaided clinical judgement = only 65% accurate
• Consensus based tools = inconsistent
• Structured Professional Judgement = often uses variables unrelated to harm
• Actuarial tools = often ignore crucial case-specific factors ; are tailored for specific populations or uses
Recommendation: when assessing complex family systems, indicative rather than purely predictive (quant) approaches are most appropriate (Barlow et al )
Structured Professional Judgement Risk analysis
• Need clinical expertise but…….
– Unaided clinical judgement is flawed due to human bias and contexts in which we work
– Need standardised measures and evidence based tools
– And direct observation
Requires combination of all elements
Examples of tools of each type (Barlow)
• Actuarial = Children’s Research Centre Structured Decision-Making
( R 8 Michigan)
• Structured Professional Judgement =
SAAF Safeguarding Assessment & Analysis Framework ( R9 )
NCFAS North Carolina Family Assessment Scale ( R10)
GCP Graded Care Profile ( R11 )
• Consensus based = Signs of Safety(R4)
• CAF??? = “ a concise conceptual model of assessment ”
Actuarial models quantify risk (ref 8)
• List confirmed risk factors and sources of evidence
• List extent and likelihood of re-occurrence
• Attribute a score to each AND an overall score EG Prior history of substantiated CP reports Prior history of substantiated DA reports Prior history of violent crime Untreated drug or alcohol abuse History of acute mental ill health EG delusional behaviour, depression Vulnerability of child ( age , disability etc. ) Lack of insight or motivation High criticism /low warmth
Static and Dynamic Risk Factors
A static risk factor is one that can’t change.
• Examples: Historical factors eg childhood history of abuse
A dynamic risk factor is one in which the level of risk can fluctuate over time, and therefore has the potential to change.
• Example: Current parenting
Moving from Uncertainty to Greater Certainty
• The assessment process needs to increase certainty/decrease uncertainty
• Do this by providing families with opportunity to demonstrate change – achieve improved parenting
• Assessing their motivation to change and acquire new parenting skills in structured manner and in timely process (4-6 months)
Capacity to Change (Dawe and Harnett: Four Stage Model)
www.capacity2change.com
• Stage one: baseline assessment and standardised measures
• Stage two: collaborative goal setting
• Stage three: time limited evidence based intervention
• Stage four: measures re-administered and progress reviewed
NSPCC Evidence Based Decisions Assessment Service
What the NCFAS tool covers( REF 7)
Environment Parental
capabilities Family
interactions
Family safety Child well-
being
Social & community
life
Self-sufficiency
Family health
Scaling for Evidence Based Decisions with NCFAS
25
The domains are scored from +2 to -3
Clear Strength
Mild Strength
Baseline/ Adequate
Mild Problem
Moderate Problem
Serious Problem
+2 +1 0 -1 -2 -3
Scores below 0 indicate a requirement for statutory intervention
NSPCC: Evaluation of the Graded Care Profile
GCP sets out to provide :
• A succinct framework for making an assessment of care of an individual child
• Baseline measurement and comparison over time
• Practice tool, giving objective measure of the quality of care in 4 domains
• Physical Care , Safety, Love & Esteem
• Considers strengths and areas for change
• Judgement about care and indications on capacity
• Based on reliable standardised evidence ( REF 12)
The GCP
Questions - Talking Points?
• What risk assessment approach or tool do you or your
agency use ?
• What are its advantages and disadvantages?
• What is the evidence for its effectiveness?
• Is it being evaluated?
• Make a note - what could you take back from today to assist increase the potential for improvement?
References
1. Working Together to Safeguard Children ( 2013) HM Government
2. Barlow, Fisher & Jones ( 2012) Systematic review of models of analysing significant harm ( DFE )
3. Dorsey S et al 2008 Child Abuse & Neglect 32 (3)
4. Turnell and Edwards ( 1999) Signs of Safety. WW Norton & Co, NY
5. Corby ( 2003 ) J of Social Welfare & Family Law 25( 3): 229
6. Ward et al ( 2012) Safeguarding babies & very young children JKP
7. D’ Andrade et al ( 2008) Jnl of Evidence-based SW 5 ( 1.2) 31-56
8. Wagner et al ( 1995) Structured decision making in Michigan: American Humane Association
References
10. National Family Preservation Network ( 2011)
11. Bentovim et al ( 2009) Safeguarding children living with family trauma. JKP
12. Srivastava & Polnay ( 1997) Field Trial of GCP Archives of Disease in Childhood 76 .4 pp 337-340